Provider Demographics
NPI:1154317238
Name:CORREA-PEREZ, MARGARITA
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:CORREA-PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:
Other - Last Name:CORREA-PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:720 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3124
Mailing Address - Country:US
Mailing Address - Phone:352-404-6959
Mailing Address - Fax:352-404-6960
Practice Address - Street 1:621 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1047
Practice Address - Country:US
Practice Address - Phone:352-404-6959
Practice Address - Fax:352-404-6960
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME898442081P0010X, 2081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000265801Medicaid
FL000265800Medicaid
FL000265801Medicaid